0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Is There Value in a Preoperative Medical Consultation?

Todd C. Lee, BSc, MD, FRCPC
Arch Intern Med. 2011;171(4):365-369. doi:10.1001/archinternmed.2011.7.
Text Size: A A A
Published online

Extract

Wijeysundera et al1 should be commended for their thought-provoking article suggesting that preoperative medical consultation is associated with worse outcomes. They performed a detailed analysis of administrative data, attempted to minimize bias with appropriate statistical techniques, and found a positive association between preoperative consultation and mortality.

The results, however compelling, are likely a product of confounding by indication, which is a significant problem when using administrative databases. Their propensity score analysis and subgroup analyses served to minimize such bias by equalizing the groups, but statistics alone cannot eliminate it. The proportion of patients with coronary artery disease, diabetes, congestive heart failure, and peripheral vascular disease was equal between the groups because of matching. But what about the severity and number of the underlying comorbidities? The “brittle” diabetic patient is more likely to be referred than the diet-controlled diabetic patient with normoglycemia. The hypertensive patient with a systolic blood pressure of 200 mm Hg is more likely to be referred than the patient with a pressure of 145 mm Hg. Among all of the comorbidities, the sickest and therefore most likely to die are also the most likely to be referred. Propensity matching in an administrative database cannot eliminate this.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Care at the Close of Life EDUCATION GUIDES
Complexities in Prognostication in Advanced Cancer

brightcove.createExperiences();